Low Back Pain and Bone Density

So, what does bone density have to do with low back pain?
The relationship between bone density and back pain is quite intimate.
In fact, when the degree of bone density declines to the point of
fracture, back pain becomes very real. The classic condition and cause
of spinal pain associated with the loss of bone density is a compression
fracture.

Compression fractures occur when the strength of the bone decreases to a point where minor trauma—and sometimes no trauma whatsoever—can
result in fracture. Compression fractures most often affect the
vertebral body (front of the spine) in the upper lumbar or lower
thoracic spine but the pain associated with these types of fractures
frequently radiates into the low back and pelvic region. In the elderly
osteoporotic spine, these types of fractures usually do not result in
spinal cord injury or nerve damage but this is quite the opposite when
compression fractures occur in younger, normal bone density individuals.
This is because when the bone is dense (or normal), the vertebral body
basically explodes or bursts, shifting some of the bony fragments back
into the spinal canal where the spinal cord is located. When bone
density decreases, there is no bursting of fragments—only collapse,
resulting in pain but no neurological damage. Besides pain, another
problem with compression fractures is that the once upright or vertical
spine is now bent and angles forward shifting the patient’s weight to
the front. This shift places yet more pressure on both the fractured
vertebra and the surrounding vertebra which increases the risk of
fracture to the surrounding adjacent vertebra. Therefore, multiple
compression fractures are not uncommon when brittle bones occur from
osteoporosis.

So, who is more at risk for osteoporosis? The usual
predictors include age (older than 65), gender (female), race (Asian or
Caucasian), low body weight, and a previous fracture. Others include
smoking, previous use of corticosteroids, a family history of fracture,
excessive alcohol use, and rheumatoid arthritis. Additionally, vitamin D
deficiency, hyperthyroidism, and celiac disease (gluten intolerance),
as well as poor balance (repeated falls), muscle weakness, and a DEXA
(dual-energy X-ray absorptiometry) T-score of -1.1 to -2.4 (osteopenia)
or -2.5 or greater (osteoporosis) are also important predictors of
brittle bone disease or osteoporosis. To best determine your risk using
these factors, go to FRAX (www.sheffield.ac.uk/frax) developed by the
World Health Organization (WHO) to determine your ten-year fracture
probability (do not just use of the T-score on the DEXA scan).

From
a treatment standpoint, it depends on the age of the patient, the
degree of osteoporosis, and whether fracture has already occurred. In
the younger osteopenic person (that is, no fractures have occurred, yet
but bone density is low), non-medication approaches such as weight
bearing exercise, no smoking, calcium / vitamin D supplementation, and
minimize the other risk factors described above may be the proper
choice. For others already with fracture, medication (bisphosphonates
such as Actonel, Boniva, and Fosamax) may be appropriate. Further,
injecting a cement into the bone (called kyphoplasty) may be appropriate
for some.

Members of ChiroTrust® have taken “The ChiroTrust Pledge”: “To the best of my ability, I agree to provide my patients convenient, affordable, and mainstream Chiropractic care. I will not use unnecessary long-term treatment plans and/or therapies.”

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This information should not be substituted for medical or chiropractic advice. Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your updated medical history.